【摘 要】
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Locally advanced pancreatic cancer located in the head or un- cinate process ( i.e. , uncus) often invades the confluence of the superior mesenteric vein (SMV), portal vein (PV), and splenic vein (SV) [ 1 , 2 ]. Additionally, chronic pancreatitis easily o
【机 构】
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Department of Surgery, Shiga General Hospital, 5-4-30 Moriyama, Moriyama City, Shiga Prefecture, 524
论文部分内容阅读
Locally advanced pancreatic cancer located in the head or un- cinate process ( i.e. , uncus) often invades the confluence of the superior mesenteric vein (SMV), portal vein (PV), and splenic vein (SV) [ 1 , 2 ]. Additionally, chronic pancreatitis easily occludes drainage flow via the SV [3] . These pancreatic diseases force sur- geons to perform en bloc resection of the SV. Simple ligation of the remnant SV without venous resection results in sinistral por- tal hypertension (PH) ( i.e. , left-sided PH), gastrointestinal bleeding, splenic congestion, and hypersplenism over the long term [ 1 , 2 ]. Postoperative sinistral PH is considered an intractable complication accompanied by refractory symptoms similar to those of PH due to liver cirrhosis [ 1 , 2 ]. Optimal management of the remnant SV is required during surgery [ 1 , 2 ]; however, intentional venous recon- struction for drainage flow of the SV is still controversial [ 1 , 2 , 4-8 ]. We herein focus on sinistral PH due to occlusion of drainage flow via the SV, present actual characteristics in typical cases of pancre- atic cancer and chronic pancreatitis, and discuss a strategic adap- tation of the distal splenorenal shunt (DSRS) procedure.
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